Berberine is a widely used bioactive compound with diverse pharmacological effects, including anti-inflammation, antioxidation, cytoprotection, broad-spectrum antibacterial and antiviral activities, as well as antitumor, antidiarrheal, antiarrhythmic, antihypertensive, hypoglycemic and lipid-regulating functions. Its pharmacological activities involve multiple systems and metabolic fields such as the digestive system, central nervous system, cardiovascular system and respiratory system. Although berberine has been used clinically for more than 60 years, its officially approved oral indications in China are still limited to intestinal infections, which fails to fully reflect its extensive pharmacological potential. The authors have previously reviewed the research progress in cerebral protection, cognitive impairment, Parkinson's disease, depression, antitumor, antiviral and hypoglycemic effects of berberine. In this article, the clinical research progress in prevention and treatment of berberine against hyperglycemia is further reviewed, so as to provide a reference for clinicians, promote the expansion of its clinical applications and give full play to its potential therapeutic value.

Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with cerebral hemorrhage complicated by pulmonary infection, so as to provide a reference for the clinical diagnosis and treatment of such patients. Methods and Results: A 21-year-old male patient was admitted due to ''dizziness accompanied by recurrent convulsions for more than 8 hours''. Emergency cranial CT revealed cerebral hemorrhage in the right frontal lobe and left parietal lobe. The patient was given nasal feeding of a prescription for acute stroke stage (Banxia Baizhu Tianma Decoction combined with blood-activating and stasis-resolving traditional Chinese medicine) to dispel wind, resolve phlegm, activate blood and unblock collaterals, together with symptomatic treatments such as dehydration to reduce intracranial pressure and seizure control. ''Craniotomy with hematoma evacuation, decompressive craniectomy and tracheotomy'' were performed on day 2, and ''total cerebral angiography via the aortic arch'' on day 4 after admission. Postoperatively, the patient developed fever with a peak temperature of 39 ℃, and lung CT suggested infection. Empirical anti-infective therapy with ceftriaxone, antipyretic treatment and resuscitation with Suhexiang Pills were administered. On day 13 after admission, the patient still had persistent high fever (40.6 ℃) with elevated infection indicators, accompanied by flushed face, red tongue with yellow and greasy coating, wiry and rapid pulse, and excessive phlegm. Modified Zhengan Xifeng Decoction was added, and a clinical pharmacist of traditional Chinese medicine was consulted. The pharmacist recommended discontinuing Suhexiang Pills and switching to Angong Niuhuang Pills, and adjusting the anti-infective regimen to moxifloxacin combined with cefoperazone-sulbactam sodium, which was adopted by the physician. On day 14, the imaging manifestations of pulmonary infection deteriorated, accompanied by liver dysfunction (considered to be related to sodium valproate). The pharmacist suggested upgrading the anti-infective drug to meropenem, adjusting the antiepileptic regimen to levetiracetam combined with topiramate, switching traditional Chinese medicine to modified Qingying Decoction, and performing next-generation sequencing (NGS) of alveolar lavage fluid and blood, which was adopted by the physician. On day 16, NGS results indicated Ureaplasma urealyticum and human herpesvirus type 1, so doxycycline and acyclovir were added. After comprehensive intervention, infection indicators gradually improved, liver function recovered, and the patient was transferred back to his native place for rehabilitation after his condition stabilized. Conclusion: Cerebral hemorrhage complicated by pulmonary infection or even bloodstream infection is clinically complex. Etiological evidence should be obtained as early as possible on the basis of empirical anti-infective therapy. Individualized treatment with integrated traditional Chinese and Western medicine should be implemented combined with liver and kidney function and changes in individual syndromes. Synergistic management of syndrome-based Chinese medicine selection and Western medicine safety is essential to improve efficacy and ensure medication safety.

Objective: To analyze the anti-infective treatment and pharmaceutical care process of a patient with severe pneumonia complicated by empyema caused by Tropheryma whipplei, so as to provide a reference for the clinical treatment and safe and rational drug use of this rare infection. Methods and Results: A patient was admitted due to ''chest pain, hemoptysis and fever for half a day'', and diagnosed with severe pneumonia with left pleural effusion. After admission, the patient received empirical anti-infective therapy with piperacillin sodium-tazobactam sodium combined with moxifloxacin. During treatment, the patient presented persistent hypokalemia and prolonged QT interval(QTc 490 ms). Tropheryma whipplei (sequence number: 108) was detected by metagenomics next-generation sequencing (mNGS) of bronchoalveolar lavage fluid. Based on the etiological examination results and drug susceptibility characteristics, the clinical pharmacist recommended switching to doxycycline combined with meropenem. After left thoracentesis and drainage, the infection was well controlled. The clinical pharmacist suggested deescalation of antibacterial drugs to ceftriaxone plus doxycycline for sequential therapy. After nearly 4 weeks of hospitalization, the patient's clinical symptoms were significantly relieved, body temperature returned to normal, infection indicators decreased remarkably, and imaging showed absorption of pulmonary lesions. The patient was discharged with continued doxycycline treatment. Conclusion: Through participation in the individualized treatment process of a patient with Tropheryma whipplei pneumonia complicated by empyema, clinical pharmacists have implemented whole-process pharmaceutical care to help optimize the anti-infective regimen and ensure medication safety, reflecting their professional value in the multidisciplinary treatment of rare pathogen infections.

Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with liver abscess complicated by pulmonary infection, and provide a reference for the clinical treatment of such patients. Methods and Results: A patient was admitted with headache, generalized soreness, cough and expectoration, nausea, vomiting, abdominal pain, high fever and chills. The admitting diagnoses were ''pulmonary infection'' and ''acute bronchitis'', and cefotaxime sodium was used for initial anti-infective therapy. As the infection continued to aggravate during treatment, the medication was adjusted to cefoperazone-sulbactam sodium (cefoperazone: sulbactam = 1:1, 3 g, q12h, intravenous infusion) after pharmacist consultation. On the 5th day of admission, the patient's symptoms still did not improve and infection indicators increased; after communication between pharmacists and physicians, the anti-infective therapeutic regimen was adjusted to cefoperazone-sulbactam sodium (cefoperazone: sulbactam = 2:1, 3 g, q8h, intravenous infusion) plus levofloxacin injection. On the 8th day of admission, the patient suffered from severe epigastric pain. Contrast-enhanced abdominal CT revealed a space-occupying lesion in the left hepatic lobe, highly suggestive of liver abscess. The clinical diagnosis of ''liver abscess'' was added, and percutaneous puncture and catheter drainage of the liver abscess was performed on the same day, without adjustment of the anti-infective therapeutic regimen. On the 13th day of admission, the patient developed bitter mouth, dry mouth, abdominal distension, abdominal pain, chest tightness and shortness of breath, and was given domperidone tablets, phloroglucinol injection and Zhichuanling Injection for symptomatic treatment. On the first day of this treatment, the patient presented with involuntary hand movement, restlessness, hallucination and impulsive behavior. After correlation analysis of adverse drug reactions, the pharmacist recommended discontinuing domperidone tablets, Zhichuanling Injection and levofloxacin and sodium chloride injection; the neurological symptoms resolved completely after drug withdrawal. On the 22nd day of admission, the patient's symptoms and laboratory findings improved significantly, and discharge was approved. The clinical pharmacist provided discharge medication advice, recommending amoxicillin-clavulanate potassium tablets plus metronidazole tablets. Conclusion: Through participation in the treatment and medication monitoring of a patient with liver abscess complicated by pulmonary infection, clinical pharmacists have adjusted anti-infective agents, identified and managed adverse drug reactions in a timely manner, thereby improving therapeutic efficacy and ensuring medication safety.

Objective: To analyze one case of methotrexate (MTX)-induced liver injury, collect adverse events of MTX-induced liver injury from the FDA Adverse Event Reporting System (FAERS) database and analyze the onset time, so as to provide a reference for clinical individualized medication. Methods and Results: A 38-year-old female patient diagnosed with ectopic pregnancy received conservative treatment with MTX (87 mg, single deep intramuscular injection in both buttocks). On the 4th day after drug withdrawal, serum human chorionic gonadotropin (HCG) was 441 mIU/mL; on the 7th day after drug withdrawal, serum HCG was 426 mIU/mL, with only a 3% decrease compared with that on the 4th day after MTX treatment. Liver function test results showed alanine aminotransferase (ALT) 144 U/L and aspartate aminotransferase (AST) 102 U/L, suggesting drug-induced liver injury. The patient was given Glutathione for Injection and Monoammonium Glycyrrhizinate and Cysteine and Sodium Chloride Injection for liver protection, combined with surgical treatment. Laparoscopic salpingectomy of the affected side was performed on the 8th day after drug withdrawal. On the 11th day after drug withdrawal, liver function was improved (ALT 75 U/L, AST 54 U/L). On the 13th day after drug withdrawal, the patient was discharged with stable condition, continued to take diammonium glycyrrhizinate enteric-coated capsules for liver protection, and was scheduled for reexamination of liver function and serum HCG one week later. On the 22nd day after drug withdrawal, liver function test results showed ALT 46.9 U/L and negative serum HCG. Meanwhile, based on relevant data from the FAERS database, with indication limited to ectopic pregnancy and study period from 2004 to 2024, a total of 56 adverse events related to liver injury were screened. The system organ classes included hepatobiliary diseases and various examinations, and the preferred terms for liver function injury in examinations mainly included abnormal liver function test, elevated liver enzymes, elevated serum bilirubin, etc. The onset time of MTX-induced liver injury ranged from 2 days to 30 days. Conclusion: Clinical attention should be paid to MTX-induced liver dysfunction. Liver function test should be carried out as early as the 2nd day after medication, and the period within 30 days is the key monitoring window.

Objective: To establish a risk prediction model for high plasma concentration of doxycycline in children aged 8-18 years with Mycoplasma pneumoniae pneumonia (MMP), so as to provide a basis for clinically precise adjustment of dosage regimens. Methods: A retrospective cohort study was performed. Clinical data were collected from children aged 8-18 years with MPP who received doxycycline treatment in The First People's Hospital of Zhengzhou from April 2023 to April 2024. Steady-state plasma concentration on day 7 was measured (with not less than 1.5 mg/L defined as high concentration). Univariate and multivariate Logistic regression analysis was used to screen risk factors and establish the prediction equation. Receiver operating characteristic (ROC) curve was utilized to evaluate model performance including area under curve (AUC), sensitivity, specificity and other indicators. Results: A total of 117 children were enrolled (29 in the high-concentration group, 88 in the low-concentration group). Multivariate analysis results showed that body weight (OR=1.117, 95%CI: 1.052-1.186), alanine transaminase (ALT) (OR=0.914, 95%CI: 0.856-0.976) and estimated glomerular filtration rate (eGFR) (OR=1.063, 95%CI: 1.018-1.110) were independent influencing factors for high plasma concentration of doxycycline in children with MMP. The prediction model equation was: logit (P) = 0.111 × body weight (kg) - 0.090 × ALT (U/L) + 0.061 × eGFR (mL/(min·1.73 m²)) - 1.856. The model achieved AUC of 0.915 (95%CI: 0.853-0.978), sensitivity of 0.929, specificity of 0.966, accuracy of 0.957 and Youden index of 0.895. The Hosmer-Lemeshow test indicated good model calibration (P=0.823). Conclusion: The prediction model constructed in this study presents high predictive performance for high plasma concentration of doxycycline in children aged 8-18 years with MMP, and may provide a reference for individualized clinical dosing regimens.

Objective: To comprehensively assess the clinical comprehensive value of four domestically marketed neurokinin-1 (NK-1) receptor antagonists (Aprepitant Capsules, Aprepitant Injection, Fosaprepitant Dimeglumine for Injection, Netupitant and Palonosetron Hydrochloride Capsules) in preventing and treating chemotherapy-induced nausea and vomiting (CINV), so as to provide a reference for individualized patient therapy and drug selection in medical institutions. Methods: Based on the evaluation framework established in the Rapid Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions (2nd Edition), quantitative scoring and comprehensive evaluation were performed on the above drugs in terms of pharmaceutical properties, effectiveness, safety, economy, and other attributes. Results: All four NK-1 receptor antagonists achieved a comprehensive score above 70, meeting the criteria of ''strongly recommended'' or suggested to be retained in the guidelines. The scores ranked in descending order: Netupitant and Palonosetron Hydrochloride Capsules (78.40), Aprepitant Capsules (76.53), Aprepitant Injection (74.36), and Fosaprepitant Dimeglumine for Injection (73.38). Netupitant and Palonosetron Hydrochloride Capsules performed outstandingly in pharmaceutical properties and economy; Fosaprepitant Dimeglumine showed therapeutic advantages in acute-phase CINV control; Aprepitant Capsules had more sufficient evidence for pediatric use. Conclusion: The selection and evaluation based on the Rapid Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions (2nd Edition) can support drug selection in medical institutions and promote scientific, rational and safe medication. All four NK-1 receptor antagonists exhibit satisfactory clinical utility in preventing and treating CINV and are eligible for recommendation into drug supply catalogs.